This briefing summarises NICE's recommendations for local authorities and partner organisations on tackling the more direct causes of premature mortality.

It is particularly relevant to health and wellbeing boards and others with a responsibility for, or interest in, delivering the Department of Health's Public Health Outcomes Framework for England 2013 to 2016 and the government's call for action Living well for longer: a call to action to reduce avoidable premature mortality.

All of the recommendations can be found in NICE's pathways. Some of the recommendations have been used to develop quality standards and links to these can also be found in the pathways.

Local authorities have always been involved in tackling the wider determinants of health and health inequalities. Now they also have a clear role in tackling the direct causes of premature mortality by providing health improvement services and by helping to plan and coordinate health protection services such as infectious disease control.

NICE's local government briefing on health inequalities and population health focuses on overall strategies for identifying and reducing the factors – environmental, socioeconomic, housing, education and general lifestyle – that can cause health inequalities. Often these factors will also contribute to premature mortality.

This briefing focuses on actions that local authorities can take on specific lifestyle issues, access to services and preventing unintentional injuries. It makes explicit the links between the wider determinants and a range of health outcomes linked to premature mortality. In doing so it highlights that investing in health can have benefits for wider social goals and vice versa.

Key messages

One in 3 deaths in England occur among people who are under the age of 75 (see Public Health England's Longer lives). Around two‑thirds of deaths among the under 75s (around 103,000 deaths) are caused by diseases and illnesses that are largely avoidable, including cancer, heart disease, stroke, respiratory and liver disease (see the Department of Health's 'Living well for longer: a call to action to reduce avoidable premature mortality'). That's because many of the direct causes, such as cancer and heart disease, are preceded by long periods of ill‑health mostly caused by lifestyle related factors.

A wide range of factors can lead to illness and premature death. This includes someone's living and working conditions for example, poor housing, social isolation, and where they live. (Children who live in more deprived areas are at much greater risk of an unintentional injury – a leading cause of death among children and young people.)

These 'wider determinants' of health can adversely affect both physical and mental wellbeing and the health‑related lifestyle choices people make (for example, whether to smoke or misuse alcohol).

Often more than 1 of these factors can affect someone during their lifetime. For example, smoking rates tend to be higher among people with lower incomes and those living in poorer housing conditions. Similarly, people who become very ill tend to have a number of chronic health conditions, such as diabetes, obesity and heart disease.

Local authorities are uniquely placed to identify and lead a partnership response to the often complex causes of premature mortality and health inequalities. This includes supporting people to adopt a healthy lifestyle, for example, by ensuring there are health promotion and health protection services such as NHS Health Check[1] (The local authorities [public health functions and entry to premises by local healthwatch representatives] regulations 2013 HM Government).

The National Institute for Health and Care Excellence (NICE) is an independent organisation providing guidance and advice to improve health and social care.

For further information on how to use this briefing and how it was developed, see About this briefing.

[1] NHS Health Check is a screening and risk management programme that aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia among people aged 40–75. Although branded as NHS Health Check, the programme is now run by local authorities.